Provider Demographics
NPI:1023529575
Name:ODOM, JOSEPHINE PAULINE (CERTIFIED HAIR LOSS)
Entity type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:PAULINE
Last Name:ODOM
Suffix:
Gender:F
Credentials:CERTIFIED HAIR LOSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3236 WILCOX BLVD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-1071
Mailing Address - Country:US
Mailing Address - Phone:423-629-8070
Mailing Address - Fax:
Practice Address - Street 1:3236 WILCOX BLVD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-1071
Practice Address - Country:US
Practice Address - Phone:423-629-8070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty